Hospitalization Following Discharge From a Skilled Nursing Facility (HFS)

This HEDIS measure assesses the rate of unplanned acute inpatient and observation stays within 30 and 60 days of discharge from a skilled nursing facility (SNF). NCQA specifies that plans report a predicted probability of hospitalization as well as observed rates, to account for a member’s prior and current health, among other factors. The observed rate and predicted probability are used to calculate a calibrated observed-to-expected (O/E) ratio that assesses whether plans had more, the same or fewer hospitalizations after SNF discharge than expected, while accounting for incremental improvement across all plans over time. The O/E ratio is multiplied by the post-SNF hospitalization rate across all plans to produce a risk-standardized rate that allows national comparison.

Why It Matters

Skilled nursing facilities provide extended rehabilitative care beyond care provided during an acute hospitalization. Medicare beneficiaries requiring SNF services are among the most vulnerable, and a high rate of patient admissions post-SNF discharge may indicate inadequate quality of care in the hospital and/or a lack of appropriate care coordination. Unplanned hospitalizations after discharge from an SNF are associated with negative outcomes, including increased mortality, for Medicare beneficiaries. Unplanned admissions can be prevented by standardizing and improving coordination of care and increasing support after SNF discharge.^1,2

Historical Results – National Averages

Performance results for this measure are currently unavailable. Visit our Quality Compass page to explore data licensing options and gain access to detailed performance results for this measure.